Provider Demographics
NPI:1295821692
Name:TAYLOR, MELISSA A (CRNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5039 SWAMP ROAD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923
Mailing Address - Country:US
Mailing Address - Phone:215-230-8380
Mailing Address - Fax:215-230-8370
Practice Address - Street 1:5039 SWAMP ROAD
Practice Address - Street 2:SUITE 401
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923
Practice Address - Country:US
Practice Address - Phone:215-230-8380
Practice Address - Fax:215-230-8370
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006716C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP13591Medicare UPIN
PA042161PPLMedicare ID - Type Unspecified